M. Karr

D2 Dopamine Receptor Up-Regulation, Treatment Response, Neurological Soft Signs, and Extrapyramidal Side Effects in Schizophrenia: A Follow-Up Study with 123I-Iodobenzamide Single Photon Emission Computed Tomography in the Drug-Naive State and after Neuroleptic Treatment

BACKGROUND Animal and postmortem studies indicate that neuroleptic therapy may induce D2 dopamine receptor up-regulation in the basal ganglia. METHODS To address this phenomenon in a clinical study, we investigated the D2 dopamine receptor binding in 15 DSM-III-R schizophrenics in the drug-naive state and 3 days after completion of a standardized neuroleptic therapy (benperidol 12-16 mg/day, for 25 days) using single photon emission computed tomography (SPECT). SPECT scans were obtained 2 hours after intravenous injection of 185 MBq 123I-iodobenzamide. For analysis, basal ganglia to frontal cortex (BG/FC) ratios were calculated and the patient sample was subgrouped into patients with a favorable versus a poor treatment response. RESULTS Neuroleptic treatment led to decreased BG/FC ratios in patients with a favorable response, but increased ratios in the poor responders (df = 1, F = 4.1, p = .06). Changes of BG/FC ratios were significantly correlated with extrapyramidal side effects but not with neurological soft signs. CONCLUSIONS Our findings suggest that neuroleptic therapy may induce D2 dopamine receptor up-regulation in a subgroup of patients characterized by poor treatment response and pronounced extrapyramidal side effects.

Memory deficits in subsyndromes of chronic schizophrenia

Recent psychopathological studies consistently identified a delusional, a negative, and a disorganized subsyndrome in chronic schizophrenia. The aim of the present study was to investigate these subsyndromes with respect to declarative, procedural and working memory deficits. While the delusional subsyndrome was associated with an impaired delayed recognition, the negative subsyndrome showed a marked deficit in delayed recall. In addition, the delusional and the negative subsyndrome shared procedural memory changes. The disorganized subsyndrome was associated with neurological soft signs and a poor working memory performance. These results do not seem to be effected by severity of illness, degree of chronicity, nor attentional deficits. Our findings support the differentiation of three subsyndromes in chronic schizophrenia and suggest that memory impairment in schizophrenia may reflect the involvement of different memory systems rather than an unspecific, global deficit.

Reliability and Validity of the Knowledge about Depression and Mania Inventory

Background: The knowledge that patients with affective disorders have about their illness is attributed increasing importance. For a number of psychiatric disorders, the imparting of information about the illness is now standard treatment. However, the relevance of knowledge about a patient’s disorder has to date not been sufficiently studied. One reason for that is that only few psychometrically validated instruments for the assessment of illness knowledge exist. The aim of this study was the development and psychometric evaluation of a questionnaire to assess knowledge about affective disorders. Methods: The Knowledge about Depression and Mania Inventory (KDMI) was evaluated with a sample of 337 patients with major depression, relatives of patients with depression and schizophrenia, and controls. Results: With the 44-item KDMI, the 3 dimensions knowledge of symptoms, knowledge of treatment and knowledge of coping strategies were differentiated. From these 44 items two 22-item parallel tests were developed for follow-up assessment. The scales showed good internal consistency. There were numerous indicators of the validity and sensitivity to change of the scales. It was shown that older patients and patients with lower levels of education are less knowledgeable about affective disorders. There were significant differences in the scales of the KDMI before and after a psychoeducative group for relatives. Conclusions: The study showed that knowledge about affective disorders can be reliably and validly measured by a questionnaire. Because of its brevity the KDMI is suitable for everyday use in clinical practice, and it forms the basis for further investigation of the significance of illness knowledge, as well as for evaluation of the effects of psychotherapy in this area.

Psychosocial factors associated with knowledge about affective disorders in patients with depression.

Background: Increasing importance is attributed to the knowledge that patients have concerning their illness. For psychiatric disorders, imparting information about the illness has become a standard part of treatment. Despite the great clinical relevance of knowledge about depression, only few empirical studies on this subject have been carried out. This study aimed to identify psychosocial factors associated with greater or lesser knowledge about affective disorders. Methods: Sixty-one in-patients with depression were recruited and tested with the Knowledge about Depression and Mania Inventory. Results: Almost all patients sought specific information about their disorder prior to admission to hospital. There were large differences in patients’ knowledge about the disorder and their choice of information source. Older and less educated patients had less knowledge about affective disorders. Patients with less illness knowledge also have a less favourable illness concept, poorer interpersonal relationships and more passive coping strategies. Conclusions: The results show that knowledge about affective disorders is a central illness characteristic that has numerous implications for the ability to cope with the disorder, as well as for psychotherapeutic management. The results contribute to a clarification of the relationship between psychoeducation and psychotherapy.

Kognitive Verhaltenstherapie in und mit Gruppen – Ein Behandlungsprogramm für depressive Patienten in stationärer Behandlung

Cognitive-Behavioral Psychotherapy with and within Groups – A Treatment Program for Depressed Inpatients Background: Extensive research of cognitive behavioral therapy shows that it is an effective treatment for unipolar major depression. As the setting (e.g. inpatient vs. outpatient treatment) can influence therapeutic outcome, it is argued that modifications on treatment programs should take such settings into account. The modified treatment programs should then be evaluated within these settings. Based on these arguments, a group psychotherapy program was set up combining disorder-specific components (increasing pleasant activities and modification of dysfunctional thoughts) with a group psychotherapy approach that is more open regarding individual treatment goals. Method: The treatment program was evaluated within a naturalistic single group design. Patients who were hospitalized for unipolar major depression and took part on a therapy group were assessed pre- and post-therapy and at a 6-months follow- up. Results: 71 inpatients participated in 9 therapy groups and completed the program. Only a small number of patients (13.3%) dropped out before the end of treatment, which was interpreted as a high acceptance. The pre-post changes in degree of depressiveness (BDI, HAMD) and the 6-month follow-up results were similar to those of other controlled studies. Discussion: The advantages and disadvantages of a group psychotherapy approach are discussed, together with the limitations of the study.

Treatment utilisation of a psychoeducational group for relatives of patients with affective disorders

ZusammenfassungObwohl die Bedeutung des familiären Interaktionsverhaltens für den Verlauf affektiver Störungen mehrfach nachgewiesen werden konnte, existieren im Gegensatz zur Therapie schizophrener Erkrankungen bislang kaum systematische Konzepte für die Einbeziehung von Angehörigen affektiv erkrankter Patienten in die Behandlung. Ziel der vorliegenden Studie war die Entwicklung und Evaluation eines niederschwelligen, psychoedukativ orientierten Behandlungsprogramms. Untersucht wurde, wie viele und welche Angehörige bei einem solchen Gruppenangebot teilnehmen. Von den n=55 in die Untersuchung einbezogenen Patienten mit majorer Depression und bipolarer Störung nahmen Angehörige von knapp der Hälfte aller Patienten das Gruppenangebot in Anspruch. Es zeigte sich, dass häufiger Lebenspartner von männlichen als von weiblichen Patienten an der Angehörigengruppe teilnahmen. Für Angehörige bipolarer Patienten fanden sich im Vergleich zu unipolaren höhere Inanspruchnahmeraten. Zudem wiesen Patienten aus der Teilnehmergruppe ein günstigeres Krankheitskonzept und mehr Wissen über affektive Störungen auf. Patienten, deren Angehörige an der Gruppe teilnahmen, fühlten sich aber auch stärker von diesen kritisiert und nahmen weniger soziale Unterstützung im Alltag wahr. Die Ergebnisse verweisen auf die Bedeutung differenzieller familienorientierter Behandlungsangebote bei affektiven Störungen.SummaryThe relevance of family interactions in the course of affective disorders has been well described. In contrast to the situation regarding schizophrenic disorders, there are few systematic concepts for involvement of the relatives of patients with affective disorders in treatment. The goal of this study was the development and evaluation of a standardised psychoeducational treatment programme. We determined the number and characteristics of relatives accepting the offer of such a group. Relatives of almost half of 55 patients with major depression and a bipolar disorder participated in the group. Relatives of male patients were more likely to take part than relatives of female patients. Relatives of patients with a bipolar disorder were more likely to take part than relatives of patients with unipolar depression. The patients whose relatives attended the group showed a more favourable understanding of the illness and more knowledge about affective disorders, but on the other hand, felt themselves to be more strongly criticised by their relatives and had less social support than the other patients. These results emphasise the importance of differential family-focused treatment modalities in affective disorders.

Inanspruchnahme eines psychoedukativen Gruppenangebotes für Angehörige von Patienten mit affektiven Störungen

ZusammenfassungObwohl die Bedeutung des familiären Interaktionsverhaltens für den Verlauf affektiver Störungen mehrfach nachgewiesen werden konnte, existieren im Gegensatz zur Therapie schizophrener Erkrankungen bislang kaum systematische Konzepte für die Einbeziehung von Angehörigen affektiv erkrankter Patienten in die Behandlung. Ziel der vorliegenden Studie war die Entwicklung und Evaluation eines niederschwelligen, psychoedukativ orientierten Behandlungsprogramms. Untersucht wurde, wie viele und welche Angehörige bei einem solchen Gruppenangebot teilnehmen. Von den n=55 in die Untersuchung einbezogenen Patienten mit majorer Depression und bipolarer Störung nahmen Angehörige von knapp der Hälfte aller Patienten das Gruppenangebot in Anspruch. Es zeigte sich, dass häufiger Lebenspartner von männlichen als von weiblichen Patienten an der Angehörigengruppe teilnahmen. Für Angehörige bipolarer Patienten fanden sich im Vergleich zu unipolaren höhere Inanspruchnahmeraten. Zudem wiesen Patienten aus der Teilnehmergruppe ein günstigeres Krankheitskonzept und mehr Wissen über affektive Störungen auf. Patienten, deren Angehörige an der Gruppe teilnahmen, fühlten sich aber auch stärker von diesen kritisiert und nahmen weniger soziale Unterstützung im Alltag wahr. Die Ergebnisse verweisen auf die Bedeutung differenzieller familienorientierter Behandlungsangebote bei affektiven Störungen.SummaryThe relevance of family interactions in the course of affective disorders has been well described. In contrast to the situation regarding schizophrenic disorders, there are few systematic concepts for involvement of the relatives of patients with affective disorders in treatment. The goal of this study was the development and evaluation of a standardised psychoeducational treatment programme. We determined the number and characteristics of relatives accepting the offer of such a group. Relatives of almost half of 55 patients with major depression and a bipolar disorder participated in the group. Relatives of male patients were more likely to take part than relatives of female patients. Relatives of patients with a bipolar disorder were more likely to take part than relatives of patients with unipolar depression. The patients whose relatives attended the group showed a more favourable understanding of the illness and more knowledge about affective disorders, but on the other hand, felt themselves to be more strongly criticised by their relatives and had less social support than the other patients. These results emphasise the importance of differential family-focused treatment modalities in affective disorders.